Caracterización de la motivación académica de residentes en especialidades de enfermería / Characterization of Academic Motivation in Residents of Nursing Specialties

Introducción: A pesar de la contingencia epidemiológica ocasionada por la COVID-19, la formación académica de los profesionales de enfermería no cesó, y Cuba reinició el proceso de especialización de sus licenciados en cuatro especialidades. Las solicitudes de bajas definitivas recibidas en las primeras semanas motivaron a los autores a realizar este trabajo, en el que se asume que esta formación requiere de elevada motivación hacia el estudio. Objetivo: Caracterizar la motivación académica de los residentes en especialidades de enfermería en Camagüey. Métodos: Estudio descriptivo de corte transversal, realizado desde diciembre de 2020 a febrero de 2021, en los centros hospitalarios de Camagüey, donde se realiza la especialización. Se trabajó con la población de 47 residentes matriculados en las especialidades. Como métodos empíricos fueron aplicados la Escala de Motivación Educativa adaptada, la entrevista semiestructurada y la observación. Se asumieron como dimensiones: motivación intrínseca, extrínseca y amotivación. Para el análisis de los datos cuantitativos se empleó la distribución de frecuencias absolutas y el cálculo porcentual. Se cualificaron los datos mediante el análisis de contenidos del que resultaron dos categorías. Resultados: Predominó la motivación académica de tipo intrínseca en 63,00 por ciento de los residentes, seguido por la motivación extrínseca en 23,00 por ciento. Solo 5,00 por ciento se encontraba desmotivado. Conclusiones: Existen diversas tipologías de motivación académica intrínseca que guardan relación con la especialidad matriculada. Predominó la motivación dirigida al logro. Dentro de la regulación extrínseca, la mayoría de los sujetos de la muestra poseía regulación identificada, seguido por las regulaciones introyectada y externa(AU)

Introduction: Despite the epidemiological contingency caused by COVID-19, the academic training of nursing professionals did not cease, and Cuba restarted the process of specialization of its graduates in four specialties. The requests for definitive quits received in the first weeks motivated the authors to write this article, in which this training is assumed as requiring high motivation towards study. Objective: To characterize the academic motivation of residents in nursing specialties in Camagüey. Methods: Cross-sectional and descriptive study carried out from December 2020 to February 2021 in the hospital centers of Camagüey where the specialization is received. The work was completed with the population of 47 residents enrolled in the specialties. As empirical methods, the adapted educational motivation scale, the semistructured interview and observation were applied. The following dimensions were assumed: intrinsic motivation, extrinsic motivation and amotivation. For the analysis of quantitative data, distribution of absolute frequencies and percentage calculation were used. The data were qualified by means of content analysis, which yielded two categories. Results: Intrinsic academic motivation predominated, accounting for 63.00 percent of the residents; followed by extrinsic motivation, present in 23.00 percent. Only 5.00 percent were unmotivated. Conclusions: There are different typologies of intrinsic academic motivation related to the studied specialty. Achievement-directed motivation predominated. Within extrinsic regulation, most of the sample subjects had identified regulation, followed by introjected and external regulation(AU)

Fine-grained data reveal segregated mobility networks and opportunities for local containment of COVID-19.

Deriving effective mobility control measures is critical for the control of COVID-19 spreading. In response to the COVID-19 pandemic, many countries and regions implemented travel restrictions and quarantines to reduce human mobility and thus reduce virus transmission. But since human mobility decreased heterogeneously, we lack empirical evidence of the extent to which the reductions in mobility alter the way people from different regions of cities are connected, and what containment policies could complement mobility reductions to conquer the pandemic. Here, we examined individual movements in 21 of the most affected counties in the United States, showing that mobility reduction leads to a segregated place network and alters its relationship with pandemic spread. Our findings suggest localized area-specific policies, such as geo-fencing, as viable alternatives to city-wide lockdown for conquering the pandemic after mobility was reduced.

Realizing the Value of Nursing Through Innovative Regulation.

Nursing regulation is a specialty area of nursing practice that some may perceive as only performing licensing and disciplinary functions. However, highly effective boards strive to meet their mission of public protection through continuous innovation. This article describes several innovative programs initiated by a board of nursing. Among the examples include regulatory waivers during the pandemic, collaborations with stakeholder organizations, a resource for nursing peer-review committees, and an alternative remediation option for practice breakdown. With strong leadership and committed teams, regulation can both protect the public and play a part in actualizing the value of nursing.

Assessment of capacity to give informed consent for medical assistance in dying: a qualitative study of clinicians' experience.

BACKGROUND: Under the Canadian Criminal Code, medical assistance in dying (MAiD) requires that patients give informed consent and that their ability to consent is assessed by 2 clinicians. In this study, we intended to understand how Canadian clinicians assessed capacity in people requesting MAiD. METHODS: This qualitative study used interviews conducted between August 2019 and February 2020, by phone, video and email, to explore how clinicians assessed capacity in people requesting MAiD, what challenges they had encountered and what tools they used. The participants were recruited from provider mailing listserves of the Canadian Association of MAiD Assessors and Providers and Aide médicale à mourir. Interviews were audio-recorded and transcribed verbatim. The research team met to review transcripts and explore themes as they emerged in an iterative manner. We used abductive reasoning for thematic analysis and coding, and continued to discuss until we reached consensus. RESULTS: The 20 participants worked in 5 of 10 provinces across Canada, represented different specialties and had experience assessing a total of 2410 patients requesting MAiD. The main theme was that, for most assessments, the participants used the conversation about how the patient had come to choose MAiD to get the information they needed. When the participants used formal capacity assessment tools, this was mostly for meticulous documentation, and they rarely asked for psychiatric consults. The participants described how they approached assessing cases of nonverbal patients and other challenging cases, using techniques such as ensuring a quiet environment and adequate hearing aids, and using questions requiring only "yes" or "no" as an answer. INTERPRETATION: The participants were comfortable doing MAiD assessments and used their clinical judgment and experience to assess capacity in ways similar to other clinical practices. The findings of this study suggest that experienced MAiD assessors do not routinely require formal capacity assessments or tools to assess capacity in patients requesting MAiD.

Teoria das filas e sua aplicação no serviço público de saúde / Queue theory and their application in the public health service

Formulada em 1908, pelo dinamarquês Agner Krarup Erlang, a teoria das filas é um método estatístico que utiliza cálculos matemáticos de probabilidade com o objetivo de prover um modelo que explique a formação de uma fila com base no padrão de entrada, atendimento e saída (OLIVEIRA et al., 2017). A finalidade de tais estudos é melhorar o desempenho do serviço e reduzir os custos. Foram citados três aplicações da teoria no serviço público: um trabalho realizado em Duque de Caxias (RJ); um estudo de caso realizado no Hospital das Clínicas de Uberlândia e um realizado no Estado do Rio de Janeiro

Formulated in 1908 by the Danish Agner Krarup Erlang, the theory of queues is a statistical method that uses mathematical probability calculations in order to provide a model that explains the formation of a queue based on the pattern of entry, service and exit (OLIVEIRA et al., 2017). The purpose of such studies is to improve service performance and reduce costs. Three applications of theory in the public service were mentioned: a work carried out in Duque de Caxias (RJ); a case study conducted at the Hospital das Clínicas de Uberlândia and one conducted in the State of Rio de Janeiro

Strategies for Success in Regulatory Readiness.

This article describes the formation of a Regulatory Advisory Council to address regulatory preparedness. The council used quality improvement methods to address data and findings from previous mock surveys and created 2 categories of work, an environment of care and clinical standards group, with checklists and work streams to improve organizational success with regulatory readiness.

Pela vida das pessoas com doenças crônicas e patologias

O encontro virtual do Comitê do CNS de acompanhamento da Covid-19 será transmitido ao vivo na quarta-feira (22/7), às 17h, pelo Facebook e Youtube. A falta de medidas efetivas de proteção à saúde e planos de apoio às pessoas com doenças crônicas e outras patologias, durante a pandemia da Covid-19, serão temas da próxima live do Conselho Nacional de Saúde (CNS) na quarta-feira (22/7), às 17h, com transmissão pelo Facebook e Youtube. Desde o início da pandemia o CNS tem manifestado preocupação com a ausência de medidas protetivas para esta população. A infecção por Covid-19 em pessoas com doenças crônicas e patologias pode representar em torno de 25% a 50%, sendo que estes pacientes apresentam maiores taxas de mortalidade devido à dificuldade de recuperação dos sintomas graves. Para debater o assunto, participarão da live do CNS o diretor do Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis (DCCI/SVS) do Ministério da Saúde, Gerson Pereira, a secretária de Articulação Política da Articulação Nacional de Luta contra a Aids (Anaids), Carla Almeida e a coordenadora da BioRede Brasil (Biored), Priscila Torres. O programa será mediado pelo conselheiro nacional de saúde Artur Custódio, que representa o Movimento de Reintegração das Pessoas Atingidas pela Hanseníase (Morhan) no CNS. O programa também terá representações dos segmentos de gestores, usuários e trabalhadores do SUS, com as participações de Maíra Botelho, diretora do Departamento de Atenção Especializada e Temática, da Secretaria de Atenção Especializada à Saúde do Ministério da Saúde, Eduardo Fróes, conselheiro nacional de saúde pela Associação Brasileira de Linfoma e Leucemia (Abrale) e Laís Souza, representante da Associação Brasileira de Ensino em Fisioterapia (Abenfisio) no CNS, respectivamente. Em abril, o Conselho solicitou ao Ministério da Saúde a apresentação de um plano de apoio para estas pessoas, com o objetivo de reduzir o risco de desenvolvimento de comorbidades e óbitos. O que se tem observado a cada dia são as dificuldades de acesso ao tratamento, baixo diagnóstico, falta de medicamentos e fechamento de atendimento ambulatorial de diferentes especialidades. Entre as medidas efetivas de proteção à saúde das pessoas com doenças crônicas e patologias, recomendadas ao Ministério da Saúde, estão: testagem prioritária, alternativas ao acesso de medicamentos com a estratégia de fornecimento ampliado (para dois ou três meses), enquanto durar o período de isolamento social e construção de protocolos específicos de atendimento a esta população. Essas estratégias devem ser voltadas às pessoas com HIV/Aids, câncer, celíacos, hanseníase, lúpus, doença falciforme, esclerose múltipla, doenças reumáticas, alzheimer, síndrome de down, Transtorno do Espectro Autista (TEA), diabetes, cardiopatas, transplantados, doenças raras, entre outras. Este é o 9º encontro virtual organizado pelo Comitê do CNS de acompanhamento da Covid-19 com transmissão ao vivo.

O conceito de "vaga zero" na Rede de Atenção às Urgências e Emergências do SUS / The concept of "zero vacancy" in the Emergency Care Network of the SUS

A Rede de Atenção às Urgências e Emergências (RUE), é uma rede complexa, composta por diferentes pontos de atenção, de forma a dar conta de todas as ações necessárias aos atendimentos de urgência. Desse modo é necessário que seus componentes atuem de forma integrada, articulada e sinérgica. Dentre as diretrizes que norteiam a implementação da RUE, estão a integralidade e regionalização da atenção, classificação de risco e a regulação do acesso aos serviços de saúde (BRASIL, 2013).

The Emergency And Emergency Care Network (RUE) is a complex network, composed of different points of care, in order to account for all the actions necessary for emergency care. Thus, it is necessary that its components act in an integrated, articulated and synergistic way. Among the guidelines that guide the implementation of the RUE are the integrality and regionalization of care, risk classification and the regulation of access to health services (BRASIL, 2013).

Evidence of COVID-19 Impacts on Occupations During the First Vietnamese National Lockdown.

Background: Although "social isolation" protects the life and health of Vietnamese citizens from the adverse effects of the COVID-19 pandemic, it also triggers massive reductions in the economic activities of the country. Objective: our study aimed to identify negative impacts of COVID-19 on occupations of Vietnamese people during the first national lockdown, including the quality and quantity of jobs as well as adverse problems at work due to COVID-19. Methods: A cross-sectional study using web-based platforms was conducted during the first time of social isolation in Vietnam at the beginning of April 2020. We utilized a respondent-driven sampling technique to select 1423 respondents from 63 cities and provinces over Vietnam. Exploratory factor analysis (EFA) was used to define sub-domains of perceived impacts of COVID-19 on occupations. Findings: Approximately two-thirds of respondents reported decreases in their income (61.6%), and 28.2% reported that their income deficit was 40% and above. The percentage of female individuals having decreased revenue due to COVID-19 was higher than that of male respondents (65.2% and 54.7%, respectively). "Worry that colleagues exposed to COVID-19 patients" and "Being alienated because employment-related to COVID-19" accounted for the highest score in each factor. Compared to healthcare workers, being self-employed/unemployed/retired were less likely to suffer from "Increased workload and conflicts due to COVID-19" and "Disclosure and discrimination related to COVID-19 work exposure." Conclusion: Our study revealed a drastic reduction in both the quality and quantity of working, as well as the increased fear and stigmatization of exposure to COVID-19 at workplaces. Health protection and economic support are immediate targets that should be focused on when implementing policies and regulations.

Prevalence and predictors of early COVID-19 behavioral intentions in the United States.

Despite early warnings and calls for action, COVID-19 infection rates continue to climb in many areas of the United States. The current study examined participants' reported likelihood of engaging in eight behaviors designated by the Centers for Disease Control and Prevention as critical for the prevention of COVID-19 at the outset of the epidemic. Self-efficacy, perceived threat, and internal and external health locus of control were explored as potential predictors of those behaviors. In addition, demographic and contextual factors, such as age, gender, political identity, and whether or not participants were currently living under a quarantine advisory, were recorded for analysis. Overall, participants reported high engagement with the prevention behaviors. Higher levels of self-efficacy, perceived severity of the illness, and external locus of control in regard to medical professionals were all positively associated with plans to take the recommended precautions. Based on the results, it appears that messaging regarding COVID-19 prevention may be particularly effective when it focuses on the high risk of the illness, the ease with which the prevention behaviors can be taken, and a reassurance that the medical establishment has individuals' best health in mind when it makes its specific recommendations. While numerous countries have succeeded in reducing the spread of COVID-19, the number of new cases in the United States remains high, even relative to other populations also heavily impacted by the disease [1]. Although it would be difficult to pinpoint a single cause or explanation for the epidemic's course in the USA, at the heart of its spread, like the spread of all infectious diseases, is noncompliance with preventative measures. The current research served as a preliminary exploration of the prevalence and predictors of eight COVID-19 prevention behaviors. A brief survey was sent out at the end of March 2020 to 350 U.S. residents in order to assess the likelihood of their engaging in various prevention behaviors recommended at that time and several related psychosocial factors. The psychological factors assessed included health locus of control (HLOC) beliefs, self-efficacy, and perceived threat. In addition, a handful of demographic and contextual factors, such as age, gender, political identity, and whether or not they were working outside the home or were currently living under a quarantine advisory, were recorded for examination.

Lifting lockdown policies: A critical moment for COVID-19 stigma.

COVID-19 'lockdown' policies may have unintended consequences for individuals, households and country economies. Hence lockdown may be unsustainable despite the risk of a resurgence of new COVID-19 infections. The repeal and alteration of lockdown policies mark a symbolic transfer of responsibility for epidemic control from state to individual. This has the potential to catalyse fear, blame and judgement within and between populations. We draw on experience from the HIV pandemic to show that this will worsen during later phases of the pandemic if COVID-19 stigma increases, as we fear it could. We suggest policy recommendations for 'lockdown lifting' to limit COVID-19 stigma. We suggest three policy priorities to minimise potential increases in COVID-19 stigma: limit fear by strengthening risk communication, engage communities to reduce the emergence of blaming, and emphasise social justice to reduce judgement. 'Lockdown' policies cannot continue uninterrupted. However, lifting lockdown without unintended consequences may prove harder than establishing it. This period has the potential to see the emergence of fear, blame and judgement, intersecting with existing inequalities, as governments seek to share responsibility for preventing further Sars-Cov-2 transmission. As we have learned from HIV, it is critical that a wave of COVID-19 stigma is prevented from flourishing.

New guidance on the regulation of allergen products: key aspects and outcomes.

PURPOSE OF REVIEW: Key aspects and outcomes from the recently published guidance on the regulation of allergen products are summarized. RECENT FINDINGS: A new regulatory guideline has been published to enhance harmonized national approaches on the regulation of allergen products and thereby strengthen the availability of high-quality products across the European Union (EU). As the guideline was developed, critical aspects for allergen products regulation were identified and are discussed in the document, including recommendations on the regulatory procedures to be applied for diagnostics, allergen immunotherapy products and named-patient products. SUMMARY: The new guidance is expected to provide clarifications on and support harmonization of the regulation of allergen products in the EU.

COVID-19: a perspective for lifting lockdown in Zimbabwe.

The Coronavirus disease 2019 (Covid-19) scourge has challenged the world's health systems and presented multiple socio-economic and public health challenges to the states it has affected. Zimbabwe has been affected by the pandemic, and in response, the government has set up an array of measures, including a national lockdown, to curb transmission. While it is critical to maintain such vigorous containment measures, socio-economic pressures in Zimbabwe will challenge the sustainability of the lockdown. Given the potential for lift of the lockdown before the Covid-19 pandemic ends, we discuss the Covid-19 pandemic situation in Zimbabwe and viewpoints on important considerations and strategies for lifting the lockdown.

The alcohol deficit: Canadian government revenue and societal costs from alcohol. / Déficit associé à l'alcool : recettes publiques et coûts pour la société associés à l'alcool au Canada.

This summary article compares government revenue from the sale and distribution of alcohol to the societal costs caused by alcohol use for the year 2014. Statistics Canada data reported government revenue of $10.9 billion; however, this was offset by net societal costs of $14.6 billion, as reported by Canada's national substance use surveillance system, the Canadian Substance Use Costs and Harms project. The societal costs include health care, economic loss of production, criminal justice and other direct costs. Though revenue from alcohol sales has been described as a benefit to public coffers, accounting that includes costs incurred shows that all provinces and territories in Canada are running an alcohol deficit, totalling $3.7 billion nationally.

Canada runs an alcohol deficit of $3.7 billion per year, when accounting considers both government revenue and societal costs from established sources. Government revenue totalled $10.9 billion in 2014, but this was more than offset by societal costs of $14.6 billion, as reported by the Canadian Substance Use Costs and Harms project. Societal costs include health care, lost productivity, criminal justice and other direct costs. Among provinces and on a per capita basis, Alberta had the lowest government revenue and the highest alcohol deficit.

Le Canada subit un déficit associé à l'alcool d'environ 3,7 milliards de dollars par année si on comptabilise à la fois les recettes publiques et les coûts pour la société provenant de sources établies. Les recettes publiques étaient de 10,9 milliards de dollars en 2014, mais ce montant a été plus que contrebalancé par des coûts pour la société de 14,6 milliards de dollars, comme le rapporte le projet Coûts et méfaits de l'usage de substances au Canada. Les coûts pour la société sont constitués des soins de santé, de la perte de productivité, de la justice pénale et de divers autres coûts directs. Au sein des provinces, et sur la base d'un calcul par habitant, c'est en Alberta que les recettes publiques sont les plus faibles et que le déficit associé à l'alcool a été le plus élevé.

Opioid Policy Changes During the COVID-19 Pandemic - and Beyond.

: The United States is currently in the midst of 2 public health emergencies: COVID-19 and the ongoing opioid crisis. In an attempt to reduce preventable harm to individuals with opioid use disorder (OUD), federal, state, and local governments have temporarily modified law and policy to increase access to OUD treatment and divert some individuals at high risk away from the correctional system. In this Commentary, we briefly describe how people with OUD are at increased risk for COVID-19, discuss existing policy barriers to evidence-based prevention and treatment for individuals with OUD, explain the temporary rollbacks of those barriers, and argue that these changes should be made permanent. We also suggest several additional steps that federal and state governments can urgently take to reduce barriers to care for individuals with OUD, both during the current crisis and beyond.

Evaluation of performance-enhancing drugs seized by Israeli enforcement agencies 2012-2017: implications for policy and regulatory change.

BACKGROUND: Illicit performance-enhancing substances are used mostly by athletes to enhance performance in sports, and by bodybuilders to gain muscle and body mass. Among performance-enhancing substances, the most common and known substances are anabolic-androgenic steroids, which are associated with a range of short and long-term adverse medical and psychiatric effects. While the sale and distribution of performance-enhancing substances are considered criminal offenses per the Israeli local pharmacy ordinance, the use and personal possession of these substances are not. Presently, the Division of Enforcement and Inspection of the Israel Ministry of Health cooperates with police and customs agents in performance-enhancing substance-related enforcement activities, which chiefly include seizures carried out at suspicious sites. Moreover, the Division of Enforcement and Inspection provides professional guidance, lab analysis services, and expert opinions on the toxicological and pharmaceutical nature of products seized. This paper presents a contemporary sub-analysis of registered seizures of performance-enhancing substances carried-out by Israel enforcement agencies. The main aim of this analysis is to characterize current patterns of performance-enhancing substances, thus providing the possibility of better assessment of current enforcement and health policy. METHODS: A sub-analysis of 712 seizures of performance-enhancing substances seized by Israeli enforcement authorities during a six-year period ranging from January 2012 to December 2017. RESULTS: This study demonstrates that Israel faces a challenge regarding the importation and distribution of illicit performance-enhancing substances. The most common substances seized were anabolic androgenic steroids (N = 539). Most seizures were carried out in the central mail processing sites, (38.4%), followed by seizures in private premises such as homes and warehouses (29.6%). Significant differences were found between anabolic-androgenic steroids and other substances, relating to place and year of seizure. Among seizures with known sources (N = 355), the most frequent geographic region given as the source of substances was Eastern Europe (47.6%), followed by East Asia (24.8%), West Asia (19.4%), and Western Europe (5.9%). Bulgaria was the country with the highest frequency of seizures (N = 71) followed by Jordan (N = 45), Thailand (N = 37) and Moldova (N = 36). Significant regional differences were found based on the variables of gender, place of seizure, and type of substance. The most frequent month of seizures was August (N = 129), followed by July (N = 119), and June (N = 118). CONCLUSIONS: While data analysis focused on the supply side of the performance-enhancing substances market, the high number of seizures of performance-enhancing substances in Israel represents evidence of the existence of a high demand and a large consumer base for these products. Consequently, there is a need for developing further enforcement, treatment, and prevention policies that do not currently exist in Israel. Policymakers should consider prioritizing law enforcement action and incentivizing intelligence sharing to monitor suspected shipment sources and specific points of entry. Additionally, the results demonstrate that there is a need in reforming the penal law to discourage the use of performance-enhancing substances. Similar measures have already been applied in countries like Spain, Italy, and Belgium. Furthermore, policy-makers should consider enhancing health ministry agencies with a higher enforcement capacity by giving them further investigative and inquiry authority. Due to the troubling magnitude of the phenomenon, policymakers should also prioritize educational and prevention strategies.